Coronary computed tomography angiography vs stress testing for stable angina evaluation: Diagnostic and prognostic superiority

Table 1 Characteristics of the selected studies

Ref.	Study design	Population characteristics	Sample size	Intervention (CCTA)	Comparator (stress testing)	Outcomes measured	Key findings	Follow-up duration
Singh et al[11]	Post hoc of RCT	Adults aged 18-75 with suspected stable angina; Scotland clinics	3283	CCTA as add-on to standard care	Exercise ECG	CHD death, nonfatal MI, diagnostic accuracy	CCTA more predictive of CHD death/MI (HR 10.63); ECG: 39% sensitivity, 91% specificity	5 years
Stillman et al[12]	Multicenter RCT	Stable angina, intermediate risk; 44 sites	1050	CCTA to guide therapy/revascularization	SPECT MPI	MACE (MI, cardiac death), revascularization	Similar outcomes (HR 1.03); CCTA better predicted MACE; fewer events in CCTA-negative patients	Mean 16.2 months
Lubbers et al[13]	Multicenter RCT	Stable angina; Dutch outpatient clinics	350	Tiered: CAC → CCTA	Functional (ECG, MPI, echo)	Event-free survival, symptoms, downstream testing, cost	Higher survival (96.7% vs 89.8%, P = 0.011); less downstream testing; lower cost	1.2 years
Lubbers et al[14]	Multicenter RCT	Stable angina; mean pretest CAD probability 54%	268	Tiered: CAC → CCTA → CT perfusion (if needed)	Functional (mostly exercise ECG)	Angiograms w/ and w/o revascularization, further testing, efficiency	Fewer unnecessary angiograms (1.5% vs 7.2%, P = 0.035); more revascularizations (88% vs 50%, P = 0.017)	6 months
Linde et al[15]	RCT	Acute chest pain with normal ECG/troponin	600	CCTA-guided; functional added if needed	Standard: Bicycle ECG or MPI	Composite: Death, MI, UAP, revascularization, readmission	Follow-up

The characteristics of the five randomized controlled trials included in this review are summarized in Table 1. These studies evaluated adult patients with suspected or confirmed stable angina or low-risk chest pain across outpatient clinics and trial networks. Interventions involved coronary computed tomography angiography, either alone or as part of a diagnostic algorithm, compared with various functional stress tests. Follow-up durations ranged from 6 months to 5 years, allowing short- and long-term assessment of outcomes including diagnostic accuracy, major adverse cardiac event, invasive angiography, and healthcare utilization. CHD: Coronary heart disease; CCTA: Coronary computed tomography angiography; RCT: Randomized controlled trial; ECG: Exercise electrocardiography; MPI: Myocardial perfusion imaging; MI: Myocardial infarction; CT: Computed tomography; CAD: Coronary artery disease; MACE: Major adverse cardiac events.